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Black cohosh, the herb most people know by the trade name Remifemin, is the leading herbal remedy for complaints of menopause. Here’s good evidence that it is effective in preventing osteoporosis.

Osteoporosis is just one of the debilities of menopause that is treated with black cohosh extracts. This woodland herb is used to relieve hot flashes, anxiety, depression, nervousness, and vaginal dryness. Extensive research has confirmed that this herb has no cytotoxic, mutagenic, carcinogenic, or teratogenic effects even when it is taken in amounts up to 100 greater than the prescribed dose. Tens of millions of women around the world use it for relief from symptoms of the change of life, and most countries in the European Union make it available under their health insurance programs.

The leading brand of black cohosh extract is a product called Remifemin. Most scientific research into the healing efficacies of black cohosh has been conducted with Remifemin. Extensive investigation into the medical use of this formulation of black cohosh has been conducted in China, where laboratory experiments confirm what millions of women already know.

If you live in a country where Remifemin is not readily available, such as the United States, any product that contains 2.5 mg of dry extract of black cohosh or 20 mg of dried herb offers roughly the same benefits.

Why would anyone use black cohosh for osteoporosis?

Scientists do not yet fully understand the mechanism of osteoporosis, but there is no doubt that primary osteoporosis in women is related to estrogen deficiency. (Secondary osteoporosis, for instance, brittle bones caused by medications, does not necessarily involve estrogen deficiency.) Bones are constantly remodeling themselves, breaking down old bone and building new bone, to accommodate changes in the weight they support and repairing microscopic fractures. As a woman’s estrogen levels fall after menopause or hysterectomy, the rate at which bone breaks down accelerates but the rate at which new bone is created stays the same. Estrogen replacement therapy (ERT) prevents and treats osteoporosis, but there are a variety of potentially disastrous side effects of ERT, including increased risk of heart attack and activation of estrogen-receptor positive cancers of the breast, cervix, and uterus.

Bisphosphonates reduce the destruction of bone but sometimes are associated with necrosis of the jawbone.  Selective estrogen receptor modulators (SERMs) for the prevention of osteoporosis prevent the breakdown of bone but cause hot flushes and also increase the risk of cardiovascular disease.

Remifemin and black cohosh products in general are clinically proven to relieve hot flushes and sleep disturbances they cause. They are also effective, if a little less potent, for relieving problems with mood and irritability in menopause. They do not carry the risk of side effects of ERT, bisphosphonates, or SERMs, and they can make a difference in preventing osteoporosis.

What is the evidence that black cohosh prevents osteoporosis?

There is no ethical method of studying the potential of black cohosh for treating postmenopausal osteoporosis in a clinical setting, but Chinese scientists have made extensive laboratory studies of Remifemin for bone health in animals. The scientists paid special attention to the effects of treatment on trabecular bone, the kind of bone at the more vulnerable ends of the femur and in the lumbar (lower) spine. To conduct their studies the scientists used female rats which had been given ovariectomies.

Studies of 120 laboratory animals showed that:

  • Remifemin prevented osteoporosis of the femur almost as well as estrogen even when it was given in just a single dose. Humans who take black cohosh, of course, take black cohosh on a daily basis.
  • The effects of Remifemin are a little slower than those of ERT. The black cohosh product does not cause side effects, but it is not as fast acting.
  • Black cohosh has its greatest benefits in weight-bearing bones.
  • And most importantly, Remifemin (and probably other forms of black cohosh) can prevent osteoporosis, but they cannot reverse it.

The Chinese scientists concluded:

Remifemin demonstrated similar effects as estradiol valerate in preventing damage to trabecular bone, improving the biomechanical properties of bone, and inhibiting bone reabsorption in ovariectomized rats. By extending the duration of treatment, the preventative effects of Remifemin on bone loss can be similar to those of estradiol valerate. In conclusion, Remifemin, with a better safety profile, may demonstrate equivalent effects as estradiol valerate in terms of preventing postmenopausal osteoporosis. This study provides strong evidence that Remifemin could be used for the prevention of clinical (postmenopausal osteoporosis).

How do you use black cohosh to prevent osteoporosis?

There is a sizable body of evidence that black cohosh products can prevent the brittle bones that follow menopause. However, there are three important principles of which to be mindful when using it:

  • Black cohosh is not for men. There can be some undesirable effects on breast growth and the size of the penis and testicles.
  • Black cohosh is not for pregnant women. Pregnant women do not typically need supplemental estrogen, and the effects of this herb during pregnancy are unpredictable.
  • The time to take black cohosh is before symptoms of osteoporosis begin. After a woman already has osteoporosis, black cohosh may slow progression of the disease, but it cannot restore demineralized bone.

  • Cui G, Leng H, Wang K, Wang J, Zhu S, Jia J, Chen X, Zhang W, Qin L, Bai W. Effects of remifemin treatment on bone integrity and remodeling in rats with ovariectomy-induced osteoporosis. PLoS One. 2013 Dec 9. 8(12):e82815. doi: 10.1371/journal.pone.0082815. eCollection 2013.
  • Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998. 15: 45-53. PubMed: 10178637.
  • Ross SM. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract 201., 26: 58-61. doi:10.1097/HNP.0b013e31823d1f67. PubMed: 22157510.
  • Photo courtesy of Wikipedia: en.wikipedia.org/wiki/Actaea_racemosa#/media/File:Cimicifuga_racemosa_002.jpg

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